纤维胆道镜在腹腔镜胆总管切开取石术中的应用

目的 探讨纤维胆道镜在腹腔镜胆总管切开取石术中的应用方法及疗效. 方法 回顾性分析我院2000年10月～2005年12月178例腹腔镜胆总管切开取石术中纤维胆道镜取石的临床应用体会. 结果 全部手术均于腹腔镜下完成,术后放置胆道内置引流管、胆总管一期缝合107例,余71例放置T管引流,无一例中转开腹,胆道镜检查取石时间平均31 min（6～92 min）,162例肝外胆管结石均于术中成功取净,术后1个月经B超检查内置管组107例中104例已排出,3例经胃镜取出,107例胆道内置引流管者随访3～51个月,平均27.8月,无胆道残余结石及胆道狭窄.16例肝内胆管结石术后检查发现胆管残余结石5例,均为术中已知残余结石,术后6周经T管窦道1～3次取出. 结论 腹腔镜胆总管切开取石术中熟练技巧应用纤维胆道镜,能可靠彻底地清除肝外胆管结石,疏通主要肝管,为胆道探查术后胆总管一期缝合提供了安全保障.

Application of fibrocholedochoscopy in laparoscopic choledocholithotomy

Objective To discuss techniques and effects of fibrocholedochoscopy in laparoscopic choledocholithotomy.Methods Clinical records of the application of fibrocholedochoscopy in laparoscopic choledocholithotomy in 178 patients with choledocholithiasis between October 2000 and December 2005 were analyzed retrospectively.Results All the operations were successfully completed under laparoscope,including endo-biliary tube drainage and primary closure of the common bile duct in 107 patients and T-tube drainage in 71 patients.No conversion to open surgery was required.The time for bile duct exploration and stone removal under fibrocholedochoscope was 6~92 min(mean,31 min).Stones were completely removed intraoperatively in all 162 patients with extrahepatic stones.Of the 107 patients with endo-biliary tube drainage,the tubes were discharged spontaneously in 104 patients(confirmed by ultrasonography 1 month after operation) and were removed under gastroscope in 3 patients.During a follow-up for 3~51 months in all the patients,no residual stones or biliary stricture were found.Among 16 patients with intrahepatic bile duct stones,residual stones were found in 5 patients(confirmed during the operation),and was extracted completely via the T-tube sinus tract after 1~3 sessions of removal at 6 postoperative weeks.Conclusions Skillful use of fibrocholedochoscope in laparoscopic common bile duct exploration can completely remove the common bile duct stones,dredge the main hepatic ducts,and make primary closure of the common bile duct after exploration possible.